VBS REGISTRATION

Welcome to the VBS registration form!

VBS is July 5 to July 9 from 6:00 P.M. to 8:30 P.M.

Please fill out completely.
Items with a red asterick are required. If you have any problems with this form please contact us.

Email: information@cfckearney.org
Phone: 816-628-4222

* Required Fields

*Are you registering more than one Child:	Yes No
*Child's First Name:
*Child's Last Name:
*Age:
*Last Grade child Completed:
*Parent or legal Guardian Name:
*Address:
*City:
*State:
*Parent or Legal Guardian home phone number:
Parent or Legal Guardian cell phone number:
Email Address:
*Emergency Contact (if parent or guardian cannot be reached):
*Emergency Contact phone number:
*Allergies or Other Medical Condition:
Home Church:
*By submitting this form you agree that all information is accurate. Christ's Fellowship Church, hereto named CFC, is not responsible for any injury occurring on CFC property. I give consent for my child to be photographed and/or video recorded and give exclusive rights to CFC in regards to photographs and videos. Furthermore CFC has the right to use all photographs and/or videos in any media form and may distribute said media as CFC sees fit. :	I Agree
*Authentication:
*2 + 3 =	Enter the correct answer to the math question.
Please click the Send button only once.